312 Ch 311. Disorders of the Pleura

Pleural disease 三大類：(1) pleural effusion (most common, transudative vs exudative — Light’s criteria)；(2) pneumothorax (spontaneous, traumatic, iatrogenic, tension)；(3) pleural malignancy (mesothelioma, metastases)；effusion 病因：transudate (CHF, cirrhosis, nephrotic, atelectasis)；exudate (parapneumonic/empyema, malignancy, PE, TB, autoimmune, drug, chylothorax, hemothorax)；diagnostic thoracentesis 是核心：cell count + protein + LDH + glucose + pH + Gram stain + culture + AFB + cytology + ADA (TB)；parapneumonic effusion：complicated → 需 drain；empyema：pus → chest tube + abx；MIST-1/MIST-2 確認 intrapleural tPA + DNase 對 loculated empyema；spontaneous pneumothorax：tall thin young men (PSP) vs underlying lung disease (SSP)；tension pneumothorax：medical emergency → needle decompression then chest tube；chronic + recurrent pleural effusions：tunneled pleural catheter (TPC, PleurX) for malignant effusion；2024-2026 mesothelioma 治療 nivolumab + ipilimumab (CheckMate 743) 為 first-line immunotherapy 突破。